pelvic organ prolapse and urinary incontinence in women · is the posterior, or back wall, of the...
TRANSCRIPT
Pelvic Organ Prolapse
and Urinary
Incontinence in
Women
Elizabeth Casiano, MD
Female Pelvic Medicine and Reconstructive Surgery
UT Health Science Center San Antonio
What is Prolapse?
Prolapse occurs when there is weakening of
the ligaments and strong tissues that hold up a
woman’s pelvic organs
This weakening allows structures to drop
down, or prolapse, similar to a hernia
This occurs due to age, pregnancy and
delivery, loss of estrogen, and doing activities
over time such as chronic coughing, straining
with bowel movements or lifting heavy objects.
Normal female anatomy
Uterine or vaginal vault
prolapse
Uterine prolapse
occurs when the
ligaments holding the
uterus up allow it to
drop into the vagina
Severity can range
from 0 to 4 with 0
meaning no prolapse
and 4 meaning
complete prolapse
Cystocele
Cystocele is like a hernia of
the anterior vaginal wall
that allows the bladder to
sag into the vagina
This can be graded in
severity in the same way
as the uterus
This can lead to difficulty
emptying the bladder and
urinary tract infections
Rectocele
Rectocele is similar to
cystocele except now it
is the posterior, or back
wall, of the vagina that
relaxes
This allows the rectum to
bulge up and into the
vagina
This is different from
rectal prolapse
Symptoms of prolapse
Many people have a combination of the different
types of prolapse
Bulge or pressure
Difficulty emptying the bladder or bowel
Recurrent urinary tract infections
Vaginal bleeding
Discomfort with or inability to have intercourse
No symptoms
When should you seek
treatment?
When the prolapse is bothering you and
interfering with your daily life
If you do have recurrent urinary tract
infections, to see if prolapse is playing a
role
Vaginal bleeding – rule out more serious
things
Non-surgical treatment
Do nothing – reassurance
Vaginal estrogen cream
Kegel exercises
Pessary – rubber-like device that sits
inside the vagina to hold the tissue up.
Needs to be fit in a clinic
Pessaries
What are Kegel exercises?
Kegel exercises are exercises of the
pelvic floor
Squeezing your levator complex muscles
Goal is to isolate just those muscles
keeping the abdomen and buttocks still
10 repetitions 3 times a day to prevent
future prolapse
Use also for urinary incontinence
Surgical treatment
Vaginal repair using native tissue (suture
plication) – may include a hysterectomy
if uterus is present
Vaginal repair with mesh
Abdominal repair with mesh
Risks of surgery and recovery
Major surgery
1-2 night hospital stay
4-6 wks of restrictions
Risks: bleeding, infection, injury to
surrounding organs, recurrence, voiding
dysfunction, pain, mesh erosion
Urinary incontinence
Urinary incontinence refers to an
involuntary loss of urine
It is very common in both men and
women.
Prevalence is 30-50% in women over 65
Causes significant bother, high costs of
incontinence supplies, admission to
nursing homes
Normal voiding patterns
2 bladder functions - Storage and
voiding
Daily voids - < 8 times per day (4-6
average)
Nightime voids – 0 or 1
Bladder capacity – 300-500 mL
Types of incontinence
Stress – leakage associated with effort of
physical exertion – cough/ laugh/ sneeze/
exercise
Urge – leakage associated with urgency
Mixed – combination of stress and urge
Overflow – leakage associated with incomplete
bladder emptying
Functional – unable to toilet due to functional
or cognitive impairment
Treatment of stress
incontinence
Kegel exercises
Pessary
FemSoft urethral insert
Midurethral sling
Urethral bulking
Treatment of urge
incontinence
Urge suppression with Kegels
Avoiding bladder irritants – caffeine,
carbonation, citrus fruits
Timed voids
Medications – anticholinergics
Botox
Sacral neuromodulation
Anticholinergic medications
Increase bladder capacity by blocking
the receptors in the bladder decreasing
detrusor function
Goal: decrease number of voids and
leaks
Side effects: dry mouth, constipation,
effects on memory and cognition
Contraindicated in uncontrolled narrow
angle glaucoma
Sacral neuromodulation
What to expect when you seek
medical attention?
Detailed discussion of your symptoms
and urinary habits
Voiding diary
Physical exam
Urinalysis
Void and check for post-void residual
Cystoscopy
Urodynamic studies
Cystoscopy
Indicated in urgency/ frequency,
hematuria, recurrent symptoms following
prior treatment
Thin scope with or without a camera
attached is placed through the urethra to
examine the urethra and bladder
Check for foreign bodies, injuries to the
bladder, rule out bladder cancer
Urodynamics
Study done to evaluate bladder
sensation, capacity, voiding abilities,
check for leakage due to urge, stress or
overflow
Patient is asked to void on her own first
Then a series of catheter are placed in te
bladder and vagina or rectum
Bladder is filled and maneuvers are done
Questions?